Can sodium and potassium measured in timed voids be used as reference instruments for validating self-report instruments? Results from a urine calibration study

Abstract

Background: Sodium and potassium measured in 24-h urine collections are often used as reference measurements to validate self-reported dietary intake instruments.

Objectives: To evaluate whether collection and analysis of a limited number of urine voids at specified times during the day ("timed voids") can provide alternative reference measurements, and to identify their optimal number and timing.

Methods: We used data from a urine calibration study among 441 adults aged 18-39 y. Participants collected each urine void in a separate container for 24 h and recorded the collection time. For the same day, they reported dietary intake using a 24-h recall. Urinary sodium and potassium were analyzed in a 24-h composite sample and in 4 timed voids (morning, afternoon, evening, and overnight). Linear regression models were used to develop equations predicting log-transformed 24-h urinary sodium or potassium levels using each of the 4 single timed voids, 6 pairs, and 4 triples. The equations also included age, sex, race, BMI (kg/m²), and log creatinine. Optimal combinations minimizing the mean squared prediction error were selected, and the observed and predicted 24-h levels were then used as reference measures to estimate the group bias and attenuation factors of the 24-h dietary recall. These estimates were compared.

Results: Optimal combinations found were as follows: single voids-evening; paired voids-afternoon + overnight (sodium) and morning + evening (potassium); and triple voids-morning + evening + overnight (sodium) and morning + afternoon + evening (potassium). Predicted 24-h urinary levels estimated 24-h recall group biases and attenuation factors without apparent bias, but with less precision than observed 24-h urinary levels. To recover lost precision, it was estimated that sample sizes need to be increased by ∼2.6-2.7 times for a single void, 1.7-2.1 times for paired voids, and 1.5-1.6 times for triple voids.

Conclusions: Our results provide the basis for further development of new reference biomarkers based on timed voids.

Clinical trial registry: clinicaltrials.gov as NCT01631240.

Keywords: attenuation factor; dietary intake reference measures; dietary measurement error; potassium intake; self-reported dietary intake; sodium intake; urinary biomarkers; validation studies.

FIGURE 1

Prediction equations for the identified optimal timed void combinations¹. ¹Mean squared prediction errors achieved by these equations are shown in Table 2. ²In the equations: ln is the natural log transformation; TVV is timed void value and the urine values, both in mg; age is in y; sex is coded male = 0, female = 1; race is coded Black = 0, other = 1; BMI = weight (kg)/height (m²); creatinine is in mg.